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Introduced Version Senate Bill 76 History

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Key: Green = existing Code. Red = new code to be enacted


Senate Bill No. 76

(By Senators Minard, Caldwell, Kessler, Anderson,

Boley, Sharpe, Rowe, Ross, Bowman and Deem)


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[Introduced January 9, 2002; referred to the Committee

on Banking and Insurance.]

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A BILL to amend chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article twenty-five-f, relating to creating the patients' access to eye care act; providing definitions; limitations on coverage; requiring certain disclosures; permitting insured persons choices of eye care providers; and other rights.

Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article twenty-five-f, to read as follows:
ARTICLE 25F. PATIENTS' ACCESS TO EYE CARE ACT.
§33-25F-1. Short title; legislative findings and purpose.
This article may be referred to as the "Patients' Access to Eye Care Act."
The Legislature finds and declares the adequate delivery of eye care services (including, but not limited to, diagnosis, treatment and management of eye disease and injury) requires direct access to eye care providers without prior authorization or referral from any other provider or entity.
§33-25F-2. Definitions.
For the purposes of this article:
(a) "Covered person" means an individual enrolled in a health benefit plan or an eligible dependent of that person.
(b) "Eye care provider" means an optometrist or ophthalmologist licensed by the state of West Virginia.
(c) "Eye or vision care benefits" means those services and material which are provided by an eye care provider who is functioning within the scope of the provider's license as determined by the appropriate licensing board.
(d) "Health benefit policy" means any individual or group plan, policy or contract for health care services issued, delivered, issued for delivery or renewed in this state by a health care corporation, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation or similar entity, when the policy or plan covers any eye or vision care benefits including, but not limited to, diagnosis and treatment of eye disease or injury, as well as ocular manifestations of other diseases or conditions.
§33-25F-3. Limitations on conditions of coverage.
(a) Health benefits policies may not prohibit the eye care provider from giving covered services to the covered persons at the highest level of licensure and competence as determined by the provider's licensing board.
(b) Health benefits policies may not require that the eye care provider hold hospital staff privileges or include any other condition or requirement not necessary for delivery of eye care upon the providers that would have the effect of excluding an individual eye care provider or class of eye care providers from participation in the health care plan.
(c) Health benefits policies may not discriminate against an individual eye care provider or a class of eye care providers in the amount of reimbursement, copayment or other financial compensation for the same or essentially similar services provided by the health benefits policy as defined by established diagnostic and procedure codes.
(d) Health benefits policies may not promote or recommend any class of eye care providers to the detriment of any other class of providers for the same or essentially similar eye care service.
(e) Any health benefits policy that includes eye or vision care benefits shall guarantee that all covered persons who are eligible for eye or vision care benefits under a health benefits policy must have direct access to the eye care provider of their choice independent of, and without referral from, any other provider or entity.
(f) Any health benefits policy that includes eye or vision care benefits shall include both optometrists and ophthalmologists in a manner that does not discriminate against any class of eye care provider and in a manner that ensures plan enrollees timely access and geographic access.
(g) This article may not be construed to require any health benefits policy to cover any specific health care service and no condition or measure may have the effect of excluding any type of class of provider licensed to provide that service.
§33-25F-4. Required disclosure.
Every health benefits policy that is issued, delivered, issued for redelivery or renewed in this state on or after the first day of July, two thousand two, shall disclose in writing to enrollees, subscribers, providers and insureds, in clear and accurate language, the enrollees's right of direct access to an eye care provider of that person's choice.
§33-25F-5. Primary care provider.
This article does not prevent a covered person from having direct access to that person's primary care provider for the treatment of eye disease or injury and being reimbursed in accordance with the terms and fee schedule of the health benefits plan.


NOTE: This bill creates the Patient's Access To Eye Care Act and sets out coverage extended to persons insured for eye care.

This article is new; therefore, strike-throughs and underscoring have been omitted.
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